Partial Splenic Embolization That Improved Esophageal Varices and Facilitated Antiviral Therapy in a Case of Cirrhosis Due to Hepatitis C

Abstract

A 57-year-old man with hepatitis C cirrhosis experienced sudden hematemesis and was brought to the hospital via ambulance. He underwent endoscopic variceal ligation for ruptured esophageal varices (EV). His platelet count was reduced to 6 X 10⁴ g/dl and splenomegaly was observed. Therefore, partial splenic embolization was performed. However, a complicating portal vein thrombus required thrombolytic therapy with warfarin. His platelet count increased to 15 X 10⁴ g/dl, the EV did not worsen, and there was no complicating hepatocellular carcinoma (HCC). Thus, a planned 24-week course of combined pegylated-interferon (Peg-IFN)-α2a and ribavirin was initiated. Neutropenia occurred during therapy, which led to a reduction in the dose and frequency of Peg-IFN-α2a administration. A sustained viral response (SVR) was obtained after completion of the treatment. The SVR has persisted up to 6 years since the EV rupture. The patient’s platelet count remains 15 X 10⁴ g/dl, the liver function remains normal, the EV have improved, and there is no complicating HCC.